PRINCETON-BLAIRSTOWN CENTER

EMPLOYMENT APPLICATION

Thank you for applying for employment with the Princeton-Blairstown Center. A complete application must also include e-mails of reference (see below).

Today's date:

-
Month
-
Day Year

PRESENT ADDRESS

Full Name

First Name Last Name

Present Address:

City:

State/Province:

Zip/Postal Code:

E-mail

Home Phone Number

-
Area Code Phone Number

Cell Phone Number

-
Area Code Phone Number

Date Address Expires:

-
Month
-
Day Year

PERMANENT ADDRESS

Permanent Address:

City:

State/Province:

Zip/Postal Code:

Home Phone Number

-
Area Code Phone Number

Will you be 19 by June 1st?

Yes No

Position Applied for:

What is your availability?

Seasonal (Summer)

How did you hear about us?

EDUCATION

Type of School:

Name of School:

Number of Years Completed:

Graduation Date:

-
Month
-
Day Year

Major or Degree:

Use this additional section in case you have more than one Major or Degree

Type of School:

Name of School:

Number of Years Completed:

Graduation Date:

-
Month
-
Day Year

Major or Degree:

Criminal, Traffic and/or Court Record

Have you ever been convicted of a misdemeanor, felony or federal offense?

Yes No

If yes, please explain:

Do you have a driver's license?

Yes No

State of issue:

EMPLOYMENT INFORMATION

Please list the last three employers in order, most recent first. Please note: We will contact two of the people on this list. Each section must either be filled in or an explanation provided.

1.

Name of Most Recent Employer:

Name of Last Supervisor:

Dates of Employment:

From:

-
Month
-
Day Year

To:

-
Month
-
Day Year

Complete Address:

Phone Number

-
Area Code Phone Number

Supervisor E-mail

Last Job Title:

Reason for Leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:

May we contact this employer?

Yes No

2.

Name of Employer:

Name of Last Supervisor:

Dates of Employment:

From:

-
Month
-
Day Year

To:

-
Month
-
Day Year

Complete Address:

Phone Number

-
Area Code Phone Number

Supervisor E-mail

Last Job Title:

Reason for Leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:

May we contact this Employer?

Yes No

3.

Name of Employer:

Name of Last Supervisor:

Dates of Employment:

From:

-
Month
-
Day Year

To:

-
Month
-
Day Year

Complete Address:

Phone Number

-
Area Code Phone Number

E-mail

Last Job Title:

Reason for Leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:

May we contact this Employer?

Yes No

REFERENCES

Please list two people who are not related to you and who are not named in the "employment" section above, who can comment on your education, work and life experiences. Please have both references fill out an on-line reference form located at: www.princeton.edu/princetonblairstown/employment/

Full Name of Reference 1

First Name Last Name

Relationship

E-mail

Phone Number

-
Area Code Phone Number

Full Name of Reference 2

First Name Last Name

Relationship

E-mail

Phone Number

-
Area Code Phone Number

Physical Requirements

Princeton-Blairstown Center program staff must be able to live and work in the outdoors in a remote place during all seasons, carry up to 35 pounds and work in high places such as ropes course and in trees.

Are you able to fulfill these physical requirements?

Yes No

If unable to fulfill physical requirements, please explain

Special Qualifications

1. Describe any work or volunteer experience with adolescents, urban youth, or adjudicated youth:

2. Describe any wilderness training or experience (such as Outward Bound or NOLS), or relevant life experiences. Include any experience belaying, rappelling, rock climbing and backpacking:

3. Describe any experience you have with team-building, service learning, problem-solving initiatives, or group games/initiatives:

4. Describe any other work or volunteer experience with youth ages 9 to18:

5. What are your current related interests or hobbies?

6. What languages other than English do you speak?

7. Tell us about your gardening experience or knowledge.

8. What experience do you have leading and/or developing environmental education activities?

9. Is there anything else you would like to tell us about that pertains to your experience and qualifications in relation to the Sustainability Intern position?

Personal Information

1. What interests you about working with youth in an adventure-based program?

2. What is important to you about your current job or studies?

3. What do you think is the greatest problem facing youth today?

4. What strengths would you bring to Princeton-Blairstown Center?

5. Describe any counseling or teaching skills you possess:

6. What does self-awareness mean to you and how do you use it?

7. To help us to get to know you better, is there anything else that qualifies you for this job that you would like to share with us?

Princeton-Blairstown Center's Policy on Smoking, Drugs and Alcohol

SMOKING: Staff are not permitted to smoke while on duty or at any time while on Center property. One warning will be given for infractions. Repeated infractions will result in disciplinary action.

DRUGS: The possession or use of any illegal drugs on Center property or at any time while employed by Princeton-Blairstown Center will be grounds for immediate termination of employment.

ALCOHOL: Possession and/or use of alcoholic beverages while on duty in leadership or support capacity is prohibited. Staff members are expected to return to the Center after time off in a "ready to work" condition. "Ready to work" is defined as neither being under the influence of alcohol nor experiencing the effects of alcohol consumption. The Co-Directors and/or their designee reserve the right to determine "ready to work" status.

The Princeton-Blairstown Center maintains an alcohol free environment during the summer season. Alcohol free means that staff may not consume, supply, encourage or condone the use of alcohol during the summer season on Center property. Violation of this policy WILL lead to disciplinary action up to and including termination.

Can you commit to Smoking/Drugs and Alcohol Policy?

Yes No

Certifications and Licenses

Please list and describe all relevant certifications and licenses.

**CPR - Type

Expiration Date

-
Month
-
Day Year

**First-Aid Type

Expiration Date

-
Month
-
Day Year

Lifeguard/ALS Type

Expiration Date

-
Month
-
Day Year

Other Certifications (teacher/social worker/WSI, etc.)

Expiration Date

-
Month
-
Day Year

**NOTE: CURRENT certification in Standard First Aid and CPR are REQUIRED prior to your first day of employment. Inquire about whether these certifications will be included in your training.

To be read and signed by applicant

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize you to make such investigations and inquiries into my past employment, educational credentials, or other employee-related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools or any other persons from all liability in responding to inquiries in connection with this application.

In the event of being an employee of Princeton-Blairstown Center, I understand that false or misleading information given in this application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Princeton-Blairstown Center as permitted by law.

Applicant's Name

First Name Last Name

Today's Date

-
Month
-
Day Year

If you would like to keep a copy of your application, please print it out before clicking the "submit" button below.